DOCSLIB.ORG

Pericardial Effusion Complicated by Tamponade: a Case Report Michele Montandona MD, Rae Wakea BM and Stephen Raimonb MBBS

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Pericardial Effusion Complicated by Tamponade: a Case Report Michele Montandona MD, Rae Wakea BM and Stephen Raimonb MBBS SSMJ Vol 5. No 4. November 2012 Downloaded from www.southsudanmedicaljournal.com MAIN ARTICLES Pericardial effusion complicated by tamponade: a case report Michele Montandona MD, Rae Wakea BM and Stephen Raimonb MBBS Introduction effusion of about 2 cm, right atrial collapse and right Pericardial effusion is fluid in the space between the ventricular collapse in diastole (Figure 2). heart and the pericardial sac. There are many causes HIV testing was negative. A further chest Xray showed of pericardial effusion, with infection (viral and TB) as the same features as the one that was brought with the the most common. If fluid rapidly accumulates in the patient. pericardial space, like in chest trauma, this fluid can Treatment and progress compress the heart (cardiac tamponade) and cause The physical examination suggested and cardiac circulatory failure. With slow accumulation of fluid, the ultrasound confirmed cardiac tamponade. An emergency pericardial sac will stretch to accommodate the fluid. pericardiocentesis was performed by a subxiphoid However, if fluid continues to accumulate, tamponade will approach using ultrasound guidance. Only 75mL of eventually occur. This is an emergency situation requiring serous (clear-yellow) fluid could be aspirated before the aspiration of pericardial fluid (pericardiocentesis). needle became blocked. However the blood pressure rose History and physical examination to 130/100 and the patient became haemodynamically stable. The pericardial fluid was smear positive for AFB so A 40-year-old South Sudanese man was referred from a the patient was started on anti-TB therapy. Unfortunately, state hospital. He complained of fever, cough productive he passed away two days later. The precise cause of death of mucoid sputum without haemoptysis and chest pain is not known but may have been due to re-accumulation for four months. He also reported weight loss for two of pericardial fluid and cardiac tamponade. months and abdominal and lower limb swelling for one month. In addition he had fatigue, palpitations and Comment exertional dyspnoea but denied orthopnoea. The patient presented with cardiac tamponade, the most He had no past history of medical or surgical severe complication of TB pericarditis. The key to urgent conditions, no known tuberculosis contacts and had never treatment was the fact that the clinicians were aware of been tested for HIV. this possible diagnosis, which was confirmed with bedside cardiac ultrasonography. Emergency pericardiocentesis On physical examination he was wasted and sleepy was possible using ultrasound to guide the insertion of but oriented and speaking in full sentences. Glasgow Coma Score 15/15. Pulse 102/minute and weak and thready. Respiratory rate 40/minute. Blood pressure 80/40. Pale but no jaundice. Pitting lower limb oedema up to the knees. Chest auscultation revealed crackles at both bases. The heart sounds were muffled but there were no added sounds, murmurs or friction rubs. The jugular venous pressure could not be determined. The abdomen was soft, distended with a fluid thrill and tender hepatosplenomegaly. Bowel sounds were normal. Investigations The patient brought a chest X-ray from the state hospital and this showed a massively enlarged cardiac silhouette and bilateral pulmonary infiltrates or oedema (Figure 1). An urgent bedside ultrasound showed a large pericardial a Massachussetts General Hospital, Department of Emergency Figure 1. Chest X-ray demonstrating enlarged cardiac silhouette Medicine, Division of Global Health and Human Rights, Boston, and bilateral pulmonary infiltrates or oedema (credit: Rae Wake. MA, USA. Permission obtained from patient) b Juba Teaching Hospital, Juba, South Sudan South Sudan Medical Journal 89 Vol 5. No 4. November 2012 SSMJ Vol 5 No 4. November 2012 Downloaded from www.southsudanmedicaljournal.com MAIN ARTICLES but it can be difficult to tell if a large heart is due to dilated cardiomyopathy or pericardial effusion. Ultrasound easily detects a large pericardial effusion: the fluid appears anechoic or black around the heart. The right atrium and right ventricle appear collapsed with dilation of the inferior vena cava [2]. In this case, the underlying cause of the pericardial effusion was rapidly established by the positive AFB smear test. However the other differential diagnoses would have included those Figure 2. Cardiac ultrasound demonstrating large pericardial effusion and right ventricular in Table 1. collapse. Impaired filling of the right ventricle during diastole is visible (arrow) during inspiration. This even increases during expiration, when right ventricle almost collapses (2 arrows). (Courtesy Tuberculous (TB) pericarditis Dr. Tom Heller, Munich) Epidemiology the aspirating needle. Nevertheless, prognosis is poor Tuberculous pericarditis, caused by once the condition has progressed to cardiac tamponade, Mycobacterium tuberculosis, is found in approximately 1% of and early diagnosis and treatment of TB pericarditis may all autopsied cases of TB and in 1% to 2% of instances prevent this potentially fatal complication. of pulmonary TB. It is the most common cause of pericarditis in Africa [3]. In one series from the Western classically presents with shortness of Pericarditis Cape Province of South Africa, tuberculous pericarditis breath and chest pain that is sharp, sudden, pleuritic and accounted for 69.5% (162 of 233) of cases referred for is relieved by sitting forward. A pericardial friction rub diagnostic pericardiocentesis [4]. By contrast, tuberculous may be heard at the left sternal border but this disappears pericarditis accounts for only 4% of cases in developed when fluid accumulates. countries [3]. The incidence of tuberculous pericarditis in Cardiac tamponade occurs when fluid in the sub-Saharan Africa is increasing as a result of the human pericardial space accumulates faster than the pericardial immunodeficiency virus (HIV) epidemic, and this trend is sac can stretch and so causes high pressure compressing likely to appear in other parts of the world [5,6]. the heart and preventing the heart from expanding fully. Recent studies of patients with TB pericarditis in sub- For example, in cardiac trauma where blood fills the Saharan Africa found the overall mortality rate in the space quickly, as little as 100mL can cause tamponade. range of 17-27%. Risk of death was higher in patients However, if the fluid accumulates more slowly as with TB with HIV infection, older age, and co-existing pulmonary pericarditis, the pericardial sac can expand to hold over tuberculosis [7,8]. one litre of fluid before critical compression arises [1]. Diagnosis The three classical signs of cardiac tamponade (also Pericardial fluid has a poor yield of about 2% (range called Beck’s triad) are hypotension, jugular venous 0-42% reported) of acid fast bacilli (AFB) on smear distention, and muffled heart sounds. Hypotension results from decreased cardiac output, jugular-venous examination but TB culture is positive in 38-56% [8]. We distension results from impaired venous return to the were therefore fortunate to find AFB on a smear from our heart and, muffled heart sounds are due to pericardial patient. A raised lymphocyte count, adenosine deaminase, fluid. There are other physical signs that may indicate protein and lactate dehydrogenase levels in the pericardial cardiac tamponade. On inspiration the central venous fluid are useful indicators of TB [9]. pressure (jugular venous pressure) would normally fall An adequate clinical assessment as described for our but with tamponade this rises. Pulsus paradoxus is the patient is always important but even more so in the absence finding of a fall in the systolic blood pressure of more of reliable laboratory tests. Evaluation for pulmonary TB than 10mmHg when the patient inspires [2]. (chest Xray and sputum AFB) and HIV may help guide your clinical diagnosis. The chest Xray of a patient with large pericardial effusion shows a large “boot-shaped” cardiac silhouette Patients from TB endemic areas who present with South Sudan Medical Journal 90 Vol 5. No 4. November 2012 SSMJ Vol 5. No 4. November 2012 Downloaded from www.southsudanmedicaljournal.com MAIN ARTICLES • Recommended treatment for TB pericarditis Table 1. Causes of pericarditis or pericardial effusion [1] includes standard 4 drug anti-TB therapy for a six Infection- viral, TB, bacterial, fungal, HIV months’ course, as well as prednisolone daily for Malignancy at least 2-3 weeks. • Primary Acknowledgement • Metastatic We thank the CEO of JTH and Dr Elijah in Post-cardiac injury syndrome (after trauma or cardiothoracic surgery) whose Medical Department we carried out this case Acute myocardial infarction (acute, delayed) study - with the verbal permission of the patient Metabolic-uremia, hypothyroidism References Collagen vascular diseases- rheumatoid arthritis, lupus erythematosus 1. Little WC, Freeman GL. Contemporary Reviews in Radiation Cardiovascular Medicine: Pericardial Disease. Circulation. Idiopathic 2006; 113: 1622-1632. 2. Khandaker MH, Espinosa RE, Nishimura RA, Sinak pericarditis must be regarded with a high index of LJ, Hayes SN, Melduni RM et al. Pericardial Disease: suspicion. In the absence of an alternative diagnosis, Diagnosis and Management. Mayo Clinic Proc. 2010 June; 85(6):572-593 patients should be started on empirical anti-tuberculosis treatment irrespective of test results [5]. 3. Mayosi BM, Burgess LJ, Doubell AF. Tuberculous Pericarditis. Circulation. 2005;112:3608-3616 Treatment 4. Sagrista-Sauleda
Load more

Recommended publications
  • Central Venous Pressure Venous Examination but Underestimates Ultrasound Accurately Reflects the Jugular
    Ultrasound Accurately Reflects the Jugular Venous Examination but Underestimates Central Venous Pressure Gur Raj Deol, Nicole Collett, Andrew Ashby and Gregory A. Schmidt Chest 2011;139;95-100; Prepublished online August 26, 2010; DOI 10.1378/chest.10-1301 The online version of this article, along with updated information and services can be found online on the World Wide Web at: http://chestjournal.chestpubs.org/content/139/1/95.full.html Chest is the official journal of the American College of Chest Physicians. It has been published monthly since 1935. Copyright2011by the American College of Chest Physicians, 3300 Dundee Road, Northbrook, IL 60062. All rights reserved. No part of this article or PDF may be reproduced or distributed without the prior written permission of the copyright holder. (http://chestjournal.chestpubs.org/site/misc/reprints.xhtml) ISSN:0012-3692 Downloaded from chestjournal.chestpubs.org at UCSF Library & CKM on January 21, 2011 © 2011 American College of Chest Physicians CHEST Original Research CRITICAL CARE Ultrasound Accurately Refl ects the Jugular Venous Examination but Underestimates Central Venous Pressure Gur Raj Deol , MD ; Nicole Collett , MD ; Andrew Ashby , MD ; and Gregory A. Schmidt , MD , FCCP Background: Bedside ultrasound examination could be used to assess jugular venous pressure (JVP), and thus central venous pressure (CVP), more reliably than clinical examination. Methods: The study was a prospective, blinded evaluation comparing physical examination of external jugular venous pressure (JVPEXT), internal jugular venous pressure (JVPINT), and ultrasound collapse pressure (UCP) with CVP measured using an indwelling catheter. We com- pared the examination of the external and internal JVP with each other and with the UCP and CVP.
    [Show full text]
  • Jugular Venous Pressure
    NURSING Jugular Venous Pressure: Measuring PRACTICE & SKILL What is Measuring Jugular Venous Pressure? Measuring jugular venous pressure (JVP) is a noninvasive physical examination technique used to indirectly measure central venous pressure(i.e., the pressure of the blood in the superior and inferior vena cava close to the right atrium). It is a part of a complete cardiovascular assessment. (For more information on cardiovascular assessment in adults, see Nursing Practice & Skill ... Physical Assessment: Performing a Cardiovascular Assessment in Adults ) › What: Measuring JVP is a screening mechanism to identify abnormalities in venous return, blood volume, and right heart hemodynamics › How: JVP is determined by measuring the vertical distance between the sternal angle and the highest point of the visible venous pulsation in the internal jugular vein orthe height of the column of blood in the external jugular vein › Where: JVP can be measured in inpatient, outpatient, and residential settings › Who: Nurses, nurse practitioners, physician assistants, and treating clinicians can measure JVP as part of a complete cardiovascular assessment What is the Desired Outcome of Measuring Jugular Venous Pressure? › The desired outcome of measuring JVP is to establish the patient’s JVP within the normal range or for abnormal JVP to be identified so that appropriate treatment may be initiated. Patients’ level of activity should not be affected by having had the JVP measured ICD-9 Why is Measuring Jugular Venous Pressure Important? 89.62 › The JVP is
    [Show full text]
  • Clinical Assessment in Acute Heart Failure
    Hellenic J Cardiol 2015; 56: 285-301 Review Article Clinical Assessment in Acute Heart Failure 1 2 NIKOLAOS S. KAKOUROS , STAVROS N. KAKOUROS 1University of Massachusetts, MA, USA; 2Cardiac Department, “Amalia Fleming” General Hospital, Athens, Greece Key words: eart failure (HF) is defined as “a clear precipitant or trigger. It is very im­ Heart failure, complex clinical syn drome that portant to establish the precipitating diagnosis, physical examination, H can result from any structural or causes, which may have therapeutic and congestion. functional cardiac disorder that impairs the prognostic implications. Approximate­ ability of the ventricle to fill with, or eject ly 60% of patients with AHF have doc­ blood.” HF has an estimated overall prev­ umented CAD. Myocardial ischemia in alence of 2.6%. It is becoming more com­ the setting of acute coronary syndromes mon in adults older than 65 years, because is a precipitant or cause, particularly in of increased survival after acute myocar­ patients presenting with de novo AHF.4 dial infarction (AMI) and improved treat­ AHF is also often precipitated by medica­ ment of coronary artery disease (CAD), tion and dietary non­compliance, as well val vular heart disease and hypertension.1 as by many other conditions, which are Acute HF (AHF) is an increasingly com­ summarized in Table 1. Once the diagno­ mon cause of hospitalizations and mortality sis of AHF is confirmed, initial therapy in­ worldwide. In the majority of patients, AHF cludes removal of precipitants; if this can Manuscript received: can be attributed to worsening chronic HF, be carried out successfully, the patient’s August 25, 2014; and approximately 40­50% of this group have subsequent course may be stable.
    [Show full text]
  • Table 1 -- Signs That Suggest Heart Failure
    TABLES FOR HEART FAILURE CLINICAL PROCESS GUIDELINES Table 1 -- Signs That Suggest Heart Failure Tachycardia Third heart sound (S3) Increased jugular venous pressure Positive hepatojugular reflux Bilateral rales Peripheral edema not due to venous insufficiency Laterally displaced apical impulse Weight gain AMDA Heart Failure Clinical Practice Guideline 2002 Table 2 -- Symptoms That Suggest Heart Failure Dyspnea on exertion Dyspnea at rest Orthopnea Paroxysmal nocturnal dyspnea Fatigue Decreased exercise tolerance Unexplained cough, especially at night Acute confusional state, delirium Abdominal symptoms (nausea, abdominal pain or distention) Decreased food intake Decline in functional status AMDA Heart Failure Clinical Practice Guideline 2002 Table 3 -- Risk Factors for Heart Failure Coronary artery disease (angina or myocardial infarction) Chronic hypertension Idiopathic dilated cardiomyopathy Valvular heart disease (e.g., mitral regurgitation, aortic stenosis) Other cardiomyopathy (e.g., sarcoidosis) Arrhythmia (e.g., sarcoidosis) Anemia Fluid volume overload with noncardiac causes Thyroid disease (hypo- or hyperthyroidism) AMDA Heart Failure Clinical Practice Guideline 2002 Table 4 -- New York Association Functional Classification Class I -- No limitations of physical activity. No shortness of breath, fatigue, or heart palpitations with ordinary physical activity. Class II -- Slight limitation of physical activity. Shortness of breath, fatigue, or heart palpitations with ordinary physical activity, but patients are comfortable at rest.
    [Show full text]
  • The Jugular Venous Pressure Revisited
    REVIEW CME EDUCATIONAL OBJECTIVE: Readers will measure and interpret the jugular venous pressure in their patients CREDIT with heart failure JOHN MICHAEL S. CHUA CHIACO, MD NISHA I. PARIKH, MD, MPH DAVID J. FERGUSSON, MD Cardiovascular Disease, John A. Burns School Assistant Professor, John A. Burns School Clinical Professor of Medicine, Department of Medicine, University of Hawaii, Honolulu of Medicine, University of Hawaii; of Cardiology, John A. Burns School The Queen’s Medical Center, Honolulu of Medicine, University of Hawaii; The Queen’s Medical Center, Honolulu The jugular venous pressure revisited ■■ ABSTRACT n this age of technological marvels, I it is easy to become so reliant on them as Assessment of the jugular venous pressure is often inad- to neglect the value of bedside physical signs. equately performed and undervalued. Here, we review Yet these signs provide information that adds the physiologic and anatomic basis for the jugular venous no cost, is immediately available, and can be pressure, including the discrepancy between right atrial repeated at will. and central venous pressures. We also describe the cor- Few physical findings are as useful but as rect method of evaluating this clinical finding and review undervalued as is the estimation of the jugular the clinical relevance of the jugular venous pressure, venous pressure. Unfortunately, many practi- especially its value in assessing the severity and response tioners at many levels of seniority and experi- to treatment of congestive heart failure. Waveforms ence do not measure it correctly, leading to a vicious circle of unreliable information, lack reflective of specific conditions are also discussed.
    [Show full text]
  • Cardiology 1
    Cardiology 1 SINGLE BEST ANSWER (SBA) a. Sick sinus syndrome b. First-degree AV block QUESTIONS c. Mobitz type 1 block d. Mobitz type 2 block 1. A 19-year-old university rower presents for the pre- e. Complete heart block Oxford–Cambridge boat race medical evaluation. He is healthy and has no significant medical history. 5. A 28-year-old man with no past medical history However, his brother died suddenly during football and not on medications presents to the emergency practice at age 15. Which one of the following is the department with palpitations for several hours and most likely cause of the brother’s death? was found to have supraventricular tachycardia. a. Aortic stenosis Carotid massage was attempted without success. b. Congenital long QT syndrome What is the treatment of choice to stop the attack? c. Congenital short QT syndrome a. Intravenous (IV) lignocaine d. Hypertrophic cardiomyopathy (HCM) b. IV digoxin e. Wolff–Parkinson–White syndrome c. IV amiodarone d. IV adenosine 2. A 65-year-old man presents to the heart failure e. IV quinidine outpatient clinic with increased shortness of breath and swollen ankles. On examination his pulse was 6. A 75-year-old cigarette smoker with known ischaemic 100 beats/min, blood pressure 100/60 mmHg heart disease and a history of cardiac failure presents and jugular venous pressure (JVP) 10 cm water. + to the emergency department with a 6-hour history of The patient currently takes furosemide 40 mg BD, increasing dyspnoea. His ECG shows a narrow complex spironolactone 12.5 mg, bisoprolol 2.5 mg OD and regular tachycardia with a rate of 160 beats/min.
    [Show full text]
  • JUGULAR VENOUS PRESSURE Maddury Jyotsna
    INDIAN JOURNAL OF CARDIOVASCULAR DISEASES JOURNAL in women (IJCD) 2017 VOL 2 ISSUE 2 CLINICAL ROUNDS 1 WINCARS JVP- JUGULAR VENOUS PRESSURE Maddury Jyotsna DEFINITION OF JUGULAR VENOUS PULSE AND The external jugular vein descends from the angle of the PRESSURE mandible to the middle of the clavicle at the posterior Jugular venous pulse is defined as the oscillating top of border of the sternocleidomastoid muscle. The external vertical column of blood in the right Internal Jugular jugular vein possesses valves that are occasionally Vein (IJV) that reflects the pressure changes in the right visible. Blood flow within the external jugular vein is atrium in cardiac cycle. In other words, Jugular venous nonpulsatile and thus cannot be used to assess the pressure (JVP) is the vertical height of oscillating column contour of the jugular venous pulse. of blood (Fig 1). Reasons for Internal Jugular Vein (IJV) preferred over Fig 1: Schematic diagram of JVP other neck veins are IJV is anatomically closer to and has a direct course to right atrium while EJV does not directly drain into Superior vena cava. It is valve less and pulsations can be seen. Due to presence of valves in External Jugular vein, pulsations cannot be seen. Vasoconstriction secondary to hypotension (as in congestive heart failure) can make EJV small and barely visible. EJV is superficial and prone to kinking. Partial compression of the left in nominate vein is usually relieved during modest inspiration as the diaphragm and the aorta descend and the pressure in the two internal
    [Show full text]
  • Reversal of Blood Flow in Deep Cerebral Vein in Preterm
    Tanaka et al. BMC Pediatrics (2020) 20:517 https://doi.org/10.1186/s12887-020-02414-0 CASE REPORT Open Access Reversal of blood flow in deep cerebral vein in preterm intraventricular hemorrhage: two case reports Kenichi Tanaka1* , Rieko Sakamoto2, Hiroko Imamura2, Tetsuo Naramura2, Shirou Matsumoto2, Masanori Iwai2, Hiroshi Mitsubuchi1 and Kimitoshi Nakamura2 Abstract Background: Intraventricular hemorrhage during the early stage is a major complication in very low birth weight infants. Elevation of venous pressure is one of the contributing factors. The internal cerebral vein receives most of the venous flow from the subependymal germinal matrix, the most common site of origin of intraventricular hemorrhage. Recently, it has been reported that pulsatile or partially interrupted internal cerebral vein waveforms might also be risk factors for intraventricular hemorrhage in extremely low birth weight infants. Here, we report two cases of partially reversed internal cerebral vein flow with intraventricular hemorrhage. There are no published reports documenting this unique flow pattern. Case presentation: Between 2013 and 2020, we had in our neonatal intensive care unit two cases of very low birth weight infants (27 and 25 weeks of gestational age) who showed a partially reversed internal cerebral vein waveform pattern, which was recognized as a new blood flow pattern. Their internal cerebral vein flow patterns were continuously flat early after birth. They showed an intraventricular hemorrhage on the unilateral side with partially interrupted internal cerebral vein flow at 31 and 41 hours after birth (27- and 25-week-old neonates, respectively). Consecutively, their internal cerebral vein flow changed to a partially reversed pattern with intraventricular hemorrhage on the contralateral side at 43 and 87 hours after birth (27- and 25-week-old neonates, respectively).
    [Show full text]
  • The Cardiovascular Examination
    CHAPTER 1 The Cardiovascular Examination KEY POINTS • The cardiovascular examination lends itself to a systematic approach. • The examination should be thorough but should be directed by the history to areas likely to be relevant. • Certain cardiovascular signs are quite sensitive and specific. • When the examination is well performed, many unnecessary investigations can be avoided. CASE 1 SCENARIO: TARA WITH 3. Pick up the patient’s hand. Feel the radial pulse. DYSPNOEA Inspect the patient’s hands for clubbing. Demon- strate Schamroth’s sign (Fig. 1.1). If there is no 34-year-old Tara was referred to the hospital by her general clubbing, opposition of the index finger (nail to practitioner. She presented with increasing dyspnoea for the nail) demonstrates a diamond shape; in clubbing last 2 weeks. She has found it difficult to lie flat in bed and this space is lost. Also look for the peripheral has been waking up frequently feeling breathless. She also stigmata of infective endocarditis. Splinter haemor- has a dry cough and has felt extremely tired for weeks. She rhages are common (and are usually caused by also has high fever with a shake. She is an intravenous drug trauma), whereas Osler’s nodes and Janeway lesions user and her general practitioner (GP) found a loud murmur (Fig. 1.2) are rare. Look quickly, but carefully, at on auscultation. each nail bed, otherwise it is easy to miss key signs. Please examine the cardiovascular system. Note the presence of an intravenous cannula and, if an infusion is running, look at the bag to see The cardiovascular system should be examined in what it is.
    [Show full text]
  • Heart Failure
    Heart Failure Table 3.63 – ASSESSMENT and MANAGEMENT of: Heart Failure ASSESSMENT MANAGEMENT Undertake ABCD assessment ● Start correcting ABC problems (refer to medical emergencies overview). If the patient is TIME CRITICAL ● Correct life-threatening conditions, airway and breathing on scene. ● Then commence transfer to nearest suitable receiving hospital. 1. Assess PERFUSION status Signs of ADEQUATE perfusion: Refer to Figure 3.13. ● Normal mentation ● Peripheral pulses present ● Systolic blood pressure >90 mmHg ● NOT pale ● Capillary Bed Refill Time <2 sec Signs of INADEQUATE perfusion: Refer to Figure 3.13. ● Reduced consciousness ● Systolic blood pressure <90 mmHg ● Pallor ● Capillary Bed Refill Time >2 sec 2. Assess CONGESTION status Refer to Figure 3.13. Medical Specific Conditions Signs of congestion: ● If pulmonary oedema is evident position the patient sitting upright if possible. 3 ● Pulmonary oedema SECTION ● Peripheral oedema ● Elevated jugular venous pulse Record a 12-lead ECG ● It is uncommon for patients with heart failure to have a normal ECG. Where no ECG abnormalities are identified clinicians should consider the possibility of an alternative diagnosis. ● Where the ECG indicates that heart failure may be due to Acute Coronary Syndrome manage as per the ACS guideline. Table 3.64 Clinical Indicators of Potential Heart Failure Pulmonary oedema Jugular venous pressure ● Fine crackling sounds are suggestive of pulmonary oedema, ● Jugular venous pressure (JVP) provides an estimation of right commonly heard in the lung bases, but may be heard over atrial filling pressure as there are no valves between the other lung fields as well. right atrium and the internal jugular vein. ● Often accompanied by the coughing up of frothy sputum, ● Jugular venous pressure is assessed while the patient is white or pink (blood stained) in colour.
    [Show full text]
  • Defining Normal Jugular Venous Pressure with Ultrasonography
    define-socran_Layout 1 14/06/10 10:53 AM Page 320 ORIGINAL RESEARCH • RECHERCHE ORIGINALE EM Advances Defining normal jugular venous pressure with ultrasonography Steven J. Socransky, MD; * Ray Wiss, MD; * Ron Robins, MD; † Alexandre Anawati, MD; * Marc-Andre Roy, MD; * I. Ching Yeung, BSc * ABSTRACT RÉSUMÉ Objective: Determination of jugular venous pressure (JVP) by Objectif : La détermination de la pression veineuse jugulaire physical examination (E-JVP) is unreliable. Measurement of (PVJ) par un examen physique (PVJ par examen) n’est pas JVP with ultrasonography (U-JVP) is easy to perform, but the fiable. La mesure de la PVJ par échographie est facile à réaliser, normal range is unknown. The objective of this study was to mais la plage normale est inconnue. L’objectif de cette étude était determine the normal range for U-JVP. de déterminer la plage normale pour la PVJ par échographie. Methods : We conducted a prospective anatomic study on a Méthodes : Nous avons réalisé une étude anatomique convenience sample of emergency department (ED) patients prospective sur un échantillon de commodité de patients de over 35 years of age. We excluded patients who had findings plus de 35 ans s’étant présentés à l’urgence. Nous avons on history or physical examination suggesting an alteration exclu les patients dont les antécédents ou l’examen médical of JVP. With the head of the bed at 45 °, we determined the suggéraient une altération de la PVJ. En positionnant la tête point at which the diameter of the internal jugular vein (IJV) du lit à 45 degrés, nous avons déterminé par échographie le began to decrease on ultrasonography (“the taper”).
    [Show full text]
  • Cardiac Tamponade: Experience from a Malaysian District Hospital Qin Jian Low1, Kuo Zhau Teo2, Lee Karl Thien1, Tzyy Huei Lim1, Seng Wee Cheo3
    J R Coll Physicians Edinb 2020; 50: 387–91 | doi: 10.4997/JRCPE.2020.407 BRIEF RESEARCH PAPER Cardiac Tamponade: experience from a Malaysian district hospital Qin Jian Low1, Kuo Zhau Teo2, Lee Karl Thien1, Tzyy Huei Lim1, Seng Wee Cheo3 ClinicalBackground Cardiac tamponade is a medical emergency. This study was Correspondence to: carried out to determine the etiologies of cardiac tamponade and review Qin Jian Low Abstract the management and outcomes. Department of Internal Medicine Methods We retrospectively analysed case records of patients who underwent Hospital Sultanah Nora pericardiocentesis for cardiac tamponade during the two consecutive years Ismail (1 January 2018 to 31 December 2019) at Hospital Sultanah Nora Ismail, Batu Pahat, in Jalan Korma Johor, Malaysia. Taman Soga 83000 Batu Pahat Results There were ten patients (eight males, two females; age range 20 to 70 years old, Johor mean age 36 years old) who underwent pericardiocentesis for cardiac tamponade during the Malaysia said period. Malignancy (40%), tuberculosis (30%), idiopathic (20%), and bacterial (10%) were among the common causes of the pericardial effusion in this center. The commonest symptoms Email: were breathlessness (90%), chest pain (60%), cough (50%), and unexplained fever (20%). [email protected] Pulsus paradoxus was the most speci c sign (100%) for the presence of echocardiographic feature of cardiac tamponade. Two of the patients with tuberculous pericarditis had retroviral disease; one patient had bacterial pericarditis due to salmonella typhi. Conclusion This study has con rmed that there are many etiologies and presentation of cardiac tamponade; clinicians should be alert as urgent pericardiocentesis is lifesaving. Keywords: cardiac tamponade, idiopathic, malignancy, outcome, pericardiocentesis, tuberculosis Financial and Competing Interests: No confl ict of interests declared Introduction Malaysia.
    [Show full text]